Financial Incentives for Weight Loss

One thing I try to do is watch Canadian news everyday to keep up with what’s going on back home.  A story on Global National from earlier this week caught my attention.  It talked about a study that showed when given financial incentives, people tend to be more successful in making healthy lifestyle changes (ie. quitting smoking, lose weight, etc.).  Check out the link to the video below.

Global National: Financial incentives to lose weight or quit smoking

The idea of using financial incentives to encourage healthy behaviours has been around for years now.  The theory goes that human beings don’t always make decisions that are in their best interest if the rewards for doing so are not immediate.  So even if a behaviour will benefit that person down the road (ie. in terms of better health), generally that benefit isn’t immediate enough for the person to make changes in their lifestyle.  If you provide people an incentive (ie. cash) in the short-term for making (and sticking with) healthy lifestyle changes you will see improved outcomes.  And from the data that I’ve seen, for the most part it seems to work.  As mentioned in the video, the people who were given cash incentives were more likely to stay smoke free, exercise more or lose weight than the people that weren’t.

On the surface this seems like a strategy governments should be implementing right away.  And maybe that’s true for certain behaviors like smoking, but I’m wholly against using this type of a program to encourage weight loss.

Here’s why:

First, it reinforces the perception that obesity is the a result of lack of willpower.  In otherwords: “You’re fat because you don’t care about your long term health enough.”  This mindset leads to weight bias and stigma.  I’ve written before about how damaging weight bias can be to the people who are victims of it.

My second issue is that it uses the assumption that weight is a marker for health.  As discussed previously, things like weight and BMI may be fine tools for assessing the health of a population, but they’re actually quite poor at assessing the health of individuals.  Just because someone is heavier doesn’t guarantee that they’re healthy and just because someone is skinny doesn’t mean that they are.

It also doesn’t necessarily factor in how that person goes about losing weight.  Unlike something like smoking (and maybe experts in this area have a counter-argument for this?), any method you use to quit is good thing.  This is clearly not true for weight loss.  If individuals aren’t provided with the support required for making permanent healthy dietary and lifestyle changes some people will invariably choose extreme dieting methods.  In addition to being an incredibly unenjoyable way to live, extreme dieting can lead to disordered eating, nutrient deficiencies and other serious health consequences.

Another concern I have with a program like this is what happens when the incentives stop?  You can’t continue to lose weight indefinitely.  At some point the individual will reach whatever has been determined as their ideal body weight.  What happens then?  Will they just go back to the behaviours that led them to excess weight in the first place?  I guess the hope is that once you’ve attained your goal weight, you will have developed enough healthy habits to be able to maintain your new size but as anyone who works with people trying to lose weight this is easier said than done.  Especially when you consider the environment we currently live in.

Which brings me to my last objection.  This type of program would do nothing to address the fact that we live in an obesogenic environment.  The truth is that we live in an era where people spend less time walking around than sitting in front of a computer or driving in their cars.  Everywhere you turn, high-calorie, nutrient-void foods are easily available and cheap.  And large multinational food corporations spend billions of dollars every year on marketing to convince you to purchase their products.

So if governments really want to make a difference in population health addressing the root causes of obesity are a much better target for policymakers than what could at best be defined as another weight loss gimmick.  I really hope this type of a program doesn’t catch on because I honestly fear it would do more harm than good.

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